Meanings of Pain by Simon van Rysewyk

Author:Simon van Rysewyk
Language: eng
Format: epub
ISBN: 9783030241544
Publisher: Springer International Publishing

labour pain triggers a woman to summon support

the challenge of labour pain marks the significance of the occasion—birthing a child

the discomfort of labour heightens the joy of receiving a baby

At a biochemical level, research has identified that pain plays a vital role in triggering a cascade of neurohormones that optimise the labour process, such as oxytocin [36]. In addition, the production of the body’s natural pain-relieving opiates—beta-endorphins—demonstrates that human physiology was designed to attenuate the nociceptive input generated by the woman’s labouring body, to facilitate her coping.

It is important to note that a distinction is made between “normal” labour pain, which is that associated with the physiological process of normal labour, and “abnormal” pain, which may be associated with a complication such as labour dystocia or damage to tissues. The working with pain view recognises that abnormal pain may warrant pharmacological intervention. However, during normal labour, the view prioritises non-pharmacological intervention to support the labouring woman. This is justified by the growing body of evidence demonstrating negative effects of pharmacological interventions on hormonally-mediated mechanisms that support and drive labour, breastfeeding and maternal-infant attachment, as well as on mothers’ and babies’ health and outcomes (See Leap and Anderson [26] and Whitburn et al. [24] for summaries). In promoting normal birth, the view focuses on supporting the labouring woman to engage with, and work through any pain associated with normal labour, rather than trying to take it away. Importantly, the working with pain view emphasises the role of the woman’s support people in helping her cope with her pain: The attitudes and actions of her support people will have a powerful influence on her own perceptions of her pain and ability to cope.

It is clear that each view assumes a different meaning for the pain associated with labour. The medicalised view does not differentiate labour pain from pains associated with pathology, injury, disease or over-applied adaptive changes to the nervous system. The meaning of labour pain is simply associated with nociceptive input from tissue damage, and its management (i.e., to relieve all pain) suggests its redundancy in the process of labour and birth. On the other hand, the working with pain view recognises that labour pain has a different context and function to other pains. Labour pain is functional pain in that it is associated with desirable (if extreme) adaptive tissue changes that occur within a normal physiological event. The working with pain view also acknowledges possible philosophical, social, and personal implications of this pain experience that, from an evolutionary perspective, are important to consider.

Ultimately, we may describe a continuum in which at one end labour pain is viewed as an unnecessary by-product of the labour and birth process that can and should be avoided. At the other end labour pain is viewed as a central component to the transformative process of becoming a mother and has several specific functions. Across the continuum are likely to be mixed, uncertain or ambivalent feelings relating to the role of pain in labour. Recognising these

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